A Retrospective Cohort Comparison of Expanded Polytetrafluorethylene to Autologous Vein for Vascular Reconstruction in Modern Combat Casualty Care

Background: Reconstruction of vascular injury often requires use of a conduit, either autologous vein (AV) or expanded polytetrafluorethylene (ePTFE). The most common anatomic locations for and durability of ePTFE as an adjunct to vascular repair in the combat setting are unknown. The objectives of this study were to characterize the anatomic locations of use of ePTFE during the wars in Afghanistan and Iraq and to compare its effectiveness to AV. Methods: US service personnel undergoing vascular repair (2002-2012) were identified. Patients in whom ePTFE was used as an interposition conduit (n = 25) were matched with similar patients who received AV (n = 24) reconstruction. Injury and operative factors were assessed, and freedom from graft-related complication was quantified using Kaplan-Meier log-rank test. Results: There was no difference between ePTFE and AV with regard to age, injury severity, or mangled extremity severity score. Follow-up for the ePTFE and AV groups was 71 and 62 months, respectively. In the cohort there was an apparent but not significantly greater freedom from graft-related complication for AV compared with ePTFE (65% vs. 17%; P = 0.13). In the carotid, subclavian, and axillary artery positions, ePTFE performed equal to AV with no apparent difference in freedom from graft-related complications (P = 0.90). However, in the periphery, AV demonstrated greater 8-year freedom from graft-related complication than ePTFE (77% vs. 31%, P = 0.044). Conclusions: AV is a more durable conduit than ePTFE in repair of wartime extremity vascular injury, whereas ePTFE is effective and durable in the carotid, subclavian, and axillary locations.